ADD Ads Exercise at Home

Here in the Philippines, may it be at daytime or night time, the major TV/Network channels have their way of luring viewers to watch. Their technique is to have what they call “Telenovelas” or “Teleseryes”. People get to be glued either in the afternoon or even during and after supper to watch local or foreign (usually Korean) translated to tagalog series. Now why in all of the topics I am covering this time has got to do with such series?

I usually see patients in the clinics wherein the relatives, caregivers or even the patient themselves complain that home exercises taught to them are not being done. Reasons usually range from there is no more time, they are tired already, no one is able to monitor the exercise, or the home exercises are too many.

My highly recommended time is then to add the exercises during “telenovela” time.

 How come? Since these major networks want to get your viewing time, they will make you watch a 30 mins to an hour show BUT their style is that they will have the “teleserye” show for around 4 to 5 mins and then followed by a 4 to 5 minute set of advertisements ranging from 10 to 15 commercials. After which the cycle begins again. 5 mins show, 5 mins advertisements until the show ends for the day. Then you will watch it again the next day, Monday to Friday. Sure you can get glued to the show for the 5 minutes but what do you do on the 5 minutes of advertisements?

My highly recommended activity, Add Ads Exercises at home!

Simply stated, you add exercises during ads time. The set of exercises that are given by the physical therapist can be done during the advertisement time. How many times? Do 1 repetition of an exercise during 1 commercial. Once that particular 5 minutes is through, you have done 1 set of 10 to 15 reps of that exercise. On the next set of advertisements, do another type of exercise or another set. By the time you are finished with 1 show, you completed it. If you are glued the whole night, then the more you have done your exercises.

Advantages:

1. It solved the no time to do it at home.

2. You won’t get tired. By doing 1 exercise per advertisement which is around 10 to 15 seconds per advertisement most likely is not that hard. And what else would you do to make your time more meaningful during those commercial breaks.

3. Monitoring. The companion of the patient can be glued to the show but during breaks can help out with the patient. It is a win-win situation.

4. Too many exercises dispersed during the whole series of shows made you enjoy your night in watching and at the same time been able to do what is needed. What more can you ask for!

Conclusion:

 Home exercises are given to help the patient carry out the program even at home. But in order to make it easier, simpler and even convenient is just by doing 1 rep of exercise per advertisement time. It may be not enough to look on a short term goal but it will be meaningful in the long term. As the saying goes, “One step at a time and you will get there eventually”.  In this case, Add 1 Ads Exercise at a time and it will make you reach your goal at the convenience of your HOME!

Importance of Physical Therapy

A local advertisment simply says it all, "Mahal ang magkasakit." (Getting sick is expensive). This is especially true for those who got hit by devastating or debilitating conditions such as strokes or similar conditions that affect the physical strength of a patient. Lets try to enumerate the would be expenses: Hospitalization, medicines, laboratory and imaging/diagnostice procedures, and profesional fees for physicians

Now comes the second part of the expenses, upon discharge of a patient and brought home its time to deal with the refitting of the residence to the present needs of the patient. Then one will include continuation of medicine, needed diagnostic test for monitoring and scheduled checkups with their physician.

Now why am I trying to enumerate all of these and yet the title is importance of Physical Therapy. Well simply stating it, a patient who is brought home and has lost the ability to be independent in activities of daily living (walking, dressing, eating, walking, bathing, working etc), needs assistance and caregiving. Which in order to achieve independence partial or complete, needs to undergo physical therapy. Now the other concern is, did physical therapy start while in the hospital or just an afterthought upon dischage?

Unfortunately, this is something that is not sometimes discussed to the patient/relatives and if by any chance discussed, may be considered as a miscellaneous expense and not a required expense. What am I pointing out? If a patient is asked to buy medicines and/or undergo physical therapy, what will the patient/relative do? The patient/relatives may opt to have both but oftentimes will opt to have the medicine and forego the physical therapy. The would be possible reasoning is, "Pwede naman yan pag lumabas na ng hospital" (That can be done already once the patient is discharged).

Again unfortunately, it may be initially less expensive if physical therapy is not done during confinement but how is it in the long run? An article done by Ruth M. Kleinpell, Kathcy Fletcher and Bonnie Jennings in Patient Safety and Quality: An Evidence-Based Handbook for Nurses pointed out the ff:

1. I quote " A dissonance exists between the hospital environment and therapeutic goal for the hospitalized elderly." (This means the goal is to make them medically stable but not functionally recovered upon discharge)
2. By Day 2 deconditioning and functional decline was evident on elderly individuals.
3. Elderly patients who was assessed during confinement showed that from day 2 to discharge, 67% showed no improvement and 10 percent showed further decline.

It then just shows that if an individual further declines in functional status that means, EXTRA care/assistance. Which is equivalent to a caregiver or nurse stay at home. If the patient is fully dependent you might need 2 caregivers in 1 duty shift. Or even to the point that the relative/love one would stop or not work in order to take care of the patient. That is lost productivity not only for the patient but also for the relative taking care of him/her.

And study shows that a deconditioned muscle (due to disuse or non use), needs 2 to 3 times the duration to be strengthened back to its original condition as compared to its deconditioning. So for example, the lower limbs lost its strength for 2 weeks of bedrest/immobility, it will need 4 to 6 weeks before it regains its former strength. And that is for young individuals, what more for elderly or those who became debilitated?

The Evidence Based Review of Stroke Rehabilitation (ESBSR), states that there is strong evidence that greater intensities of physiotherapy and occupational therapy resulted in improved functional outcomes after stroke. This then points to the fact that in the long run, which is the usual duration for those who have a stroke will benefit on early intervention to minimize potential prolonged bedridden and immobilization complications management. These complications, such as bedsores, pulmonary conditions, lower limb edema, joint stiffening, fully dependent on all activities, depression etc, may then prove more costly than having early intervention.

Table 1 shows the effect of prolonged bed rest. (click Table to enlarge)
*Source/Table were it was taken from is noted at end of article.

Conclusion: Patients who had debilitating conditions that affect their functional status during confinement should be assessed properly if early physical therapy intervention is needed or not. Talk to your attending physician so that the recommended Physical Medicine and Rehabilitation specialist can discuss and provide the benefits and consequences or early physical/occupational therapy. Know your options so that you can decide on what would be more beneficial for the patient as well as for the love ones.


* Ruth M. Kleinpell, Kathcy Fletcher and Bonnie Jennings in Patient Safety and Quality: An Evidence-Based Handbook for Nurses
Next article would be the difference between neurological and functional recovery.